Myocarditis without changes in the ECG? | Heart muscle inflammation in ECG

Myocarditis without changes in the ECG?

The ECG is able to measure electrical signals in the heart. This allows all disturbances in the excitation conduction system of the heart to be recorded. Often, inflammation of the heart muscle triggers such changes.

However, there are certainly cases in which no disturbances of the electrical signals occur. In these cases, the ECG is usually not changed or only very slightly.For example, defects in individual heart muscle cells cannot be displayed in the ECG. Even if the excitation conduction in these individual cells is disturbed, this is not noticeable in the ECG.

Only after a certain size of the defect, changes in the ECG can be detected. Even if the heart muscle cells are weakened by the inflammation, but they still transmit the electrical signals, the ECG is usually unremarkable. Thus, the affected person may already have major restrictions in heart function without this being visible in the ECG.

In addition, myocarditis can be accompanied by water retention in the pericardium. This accumulated fluid takes up space in the heart, limiting its pumping function. However, these deposits cannot be measured by an ECG. Therefore, an imaging procedure (X-ray, ultrasound or MRI) should always be performed in addition to the ECG.

Alternative Diagnostics

The changes in the ECG that occur in myocardial inflammation can have a variety of other causes. If there is no inflammation of the heart muscle, the origin of the phenomenon is usually another heart disease. For example, ST segment elevation must always be considered in the first instance as a heart attack.

Heart rhythm disturbances can also be triggered by a heart attack. During the infarction, heart muscle cells perish due to a reduced blood supply. As a result, the electrical signal line can be disturbed.

Furthermore, phenomena such as an AV block, a left bundle branch block, tachycardia or extrasystoles can occur as individual heart diseases. The triggers for these diseases are manifold. Other heart muscle diseases, such as cardiomyopathy, can also show a similar picture to myocarditis in the ECG. Cardiac insufficiency (cardiac insufficiency) is accompanied by a general functional impairment and thus also by a pumping weakness of the heart and can possibly be confused in the ECG with myocarditis.